Occurrence of female genital tuberculosis among infertile women: a study from a tertiary maternal health care research centre in South India.

The purpose of this investigation was to estimate the proportion of female genital tuberculosis (FGTB) among infertile women, along with the mean cost of diagnosis by different methods. The study was carried out on 211,335 women, of which 31,755 (15.02 %) were infertile. 202 women were highly suspected of FGTB on laparoscopy, which was later ascertained by multi-gene polymerase chain reaction (PCR), and the cost was estimated. The majority of the patients were infertile (77.23 %), with menstrual disturbances (61.88 %). Many of them were having beaded tubes (68.81 %), tubal block with hydrosalpinx (58.91 %) and tubercular salpingitis (48.01 %). Out of 302 case-controls, 105 infertile women were positive by haematoxylin and eosin staining, 14.57 % were acid-fast bacilli-positive and 86 infertile women were positive on culture. 178 (58.94 %) endo-ovarian tissue biopsies and pelvic aspirated fluid specimens were positive for a 32-kDa protein gene as amplified using multi-gene PCR. The proportion of proven FGTB cases was very high (58.94 %) among infertile women highly suspected of FGTB. The estimated cost in rupees (Rs) of FGTB diagnosis by the conventional method ranges from Rs 3.36 to 38.11, while multi-gene PCR was established as being very expensive (Rs 254.21). The expected time of FGTB diagnosis by the conventional method ranges from 0.5 to 1.83 h, whereas culture took 4-8 weeks. The logical time of FGTB diagnosis by multi-gene PCR was 6.48 h. Compared to Ziehl-Neelsen's staining and culturing, multi-gene PCR improved the detection rate of suspected FGTB. Therefore, FGTB can be diagnosed if multi-gene PCR is considered in the evaluation of infertile patients in areas where tuberculosis is endemic.